Did Minnie Riperton die needlessly of breast cancer? Many black women do It’s been more than 30 years since she died of breast cancer, but African-American singer Minnie Riperton is one artist whose 1975 hit single “Lovin’ You,” will continue to regale us through the years.
That, and her extraordinary five-and-a-half octave vocal range.
Diagnosed with breast cancer in January 1976, Riperton was one of the first celebrities to go public with her diagnosis. She later went on to become a spokesperson for the American Cancer Society, and in 1978, she received the American Cancer Society’s Courage Award, presented to her at the White House by President Jimmy Carter. She died at age 31 on July 12, 1979.
What few of us know is that Riperton is only one in a growing number of black women who are diagnosed with cancer at a very late stage.
Because they don’t have access to proper care and the right information, nearly five black women die needlessly everyday from breast cancer — that’s according to a new study published in the journal Cancer Epidemiology on March 21.
The study said that more than 1,700 black women die unnecessarily each year and that poverty and racial inequities — not genetics — are responsible for the higher death rate. In fact, according to the authors, black women are less likely than white women to get breast cancer.
But more African American women are likely to die from it — with the differences in mortality emerging in the early 1980s. By 2007, death rates were 41 percent higher among black women than among white women — even while rates for both groups were going down, the American Cancer Society says.
But this isn’t news: Doctors and researchers have long known about the disparity in national scale mortality rates. What’s new is that the study, done by researchers from the Sinai Urban Health Institute in Chicago, was the first to look at the statistics city-by-city.
Funded by the Avon Foundation, the study urges the government to commit to making access to quality breast health care — from screening to treatment — available to all women, regardless of their ability to pay. Avon supports breast cancer research and education along with other women’s causes.
What the Sinai Institute researchers did was to review statistics in the nation’s 25 largest cities. They found that 21 of these cities showed a racial disparity in the breast cancer mortality rates between black and white women. San Franciso had the smallest disparity of the cities; Memphis had the highest.
Bringing together each city’s population with the disparity, researchers came up with this estimate: each year, 1,722 black women die unnecessarily from breast cancer.
“Our research shows societal factors — not genetics — are largely to blame for the racial disparity in breast cancer mortality nationwide,” says Stephen Whitman, director of the institute and the study’s lead author.
The upside of this is that black women can play an active role in reducing their risk. “When a woman believes genetics causes her disease, it breeds a sense of hopelessness and fear,” he notes.
But quality care for all women should be made more accessible by the healthcare community — including those who are uninsured or under-insured, Dr. Whitman says. Poor women who lack access to quality care are more vulnerable to dying from breast cancer, doctors and researchers agree.
Commenting on the study, the executive director of the Black Women’s Health Imperative says, “It’s now time for researchers to go beyond calling for black women to play a more active role and call on clinicians and healthcare providers to look at access to newer and more advanced technologies to detect tumors and offer more advanced therapies for proper care and treatment.”
Eleanor Hinton Hoyt, head of the Washington-based advocacy group goes on to say the study, “doesn’t give us what we need for uncovering, addressing and eliminating … early death outcomes for black women.”
We know that mammograms as they are offered today will not solve the problem, even with early detection— black women are still dying earlier,” she says.
Breast cancer: the most common cancer worldwide
Breast cancer is the most common cancer in women worldwide and a leading cause of death in women.
The United States and United Kingdome have the highest incidence rates worldwide — together with the rest of North America and Australia/New Zealand. In these countries, breast cancer affects one in eight women during their lives.
According to the National Cancer Institute, in 2012, about 227,000 women in the U.S. will be diagnosed with breast cancer.
Experts don’t know why some women get breast cancer, but there are a number of risk factors. Risks that you can’t change include:
• Age. The chance that you will get breast cancer rises as you get older
• Genes. Two genes — BRCA1 and BRCA2 — greatly increase the risk
• Personal factors. Beginning periods before age 12 or going through menopause after age 55
• Having dense breasts
Other risks that you can do something about include being using hormone replacement therapy, taking birth control pills, not having children or having your first child after age 35, drinking alcohol, or being overweight.
Symptoms of breast cancer may include:
• a lump in the breast
• a change in size or shape of the breast or discharge from a nipple
Breast cancer is treatable and there are many people who survive for decades after their diagnosis. But it’s most treatable when it’s found early — and breast self-exam and mammography can do that.
Generally, treatment consists of radiation, lumpectomy, mastectomy, chemotherapy and hormone therapy. Men can have breast cancer, too, but the number of cases is small.
Fear and denial prevents early detection
Among black women, fear and denial also plays a part in stopping them from finding their breast cancer at an early stage.
Dr. Regina Hampton, a surgeon who specializes in benign and malignant breast disease, sees many women with good health-care coverage at her own private practice in Prince George’s County. At the same time, she also works with the Capital Breast Care Center in Washington, where she serves uninsured women.
In both settings, she said, “a lot of women come in at later stages …and what I hear from my patients is they’re all afraid.”
Indeed, 75 percent of black women rated their health as good or excellent, in a survey focusing on African American women conducted by The Washington Post and the Kaiser Family Foundation. This was about the same percentage as white women, black men and white men.
But the reality is vastly different from the perception: a 2009 Kaiser study Health notes “consistently higher rates of health challenges among black women, ranging from poor health status to chronic illness to obesity and cancer deaths.” Data from across the country shows that women of color report higher rates of disease and health problems, are more likely to be uninsured and have had fewer doctor visits for preventive care.
To be precise, experts cite some specific factors for breast cancer: Black women have a higher rate than white women of a diagnosis before age 40 and often get their diagnoses at later stages. They also appear to be more susceptible to aggressive tumors.
Then of course, there’s the classic fear — harbored by most women — that the disease will rob them of their sexuality or femininity. But aside from that, Dr. Hampton and other health experts think black women also carry anxieties resulting from a long history of having a national medical system that was inaccessible to them.
There are also some psychological factors at play: Many black women view cancer of any kind as certain death — and some believe that surgery spreads the disease, Dr. Hampton says, adding that, “one of the challenges is getting people to realize that the survival rates are very good for breast cancer if you present early.
Breast cancer “is the most treatable female cancer that we have,” she says. “I think I think that message hasn’t resonated through our community.”
But more often than not, African American women and other women of color lack the money or insurance for preventive care — and this is why many black people didn’t seek medical help until they were seriously ill.
‘We deny our pain’
In a new book, “Health First! The Black Woman’s Wellness Guide,” Hinton Hoytt of the Black Women’s Health Imperative explains the gulf between what black women say and what statistics show about their health:
“Black women invariably put on a mask. We deny our pain, grief and sorrows because we want to project an image of what I call being okay to the world and to our families and community,” she says. “We put that veil over what bothers us because so many others depend on us being in good health or being okay.”
Many findings of the Post-Kaiser survey support Hinton Hoytt’s assessment, The Washington Post reports in March 21 article.
“Black women were more likely than white women to report being worried about losing their jobs, not having enough money to pay their bills, being a victim of a violent crime and being discriminated against. They are more often responsible for their elderly relatives’ financial needs and more likely to provide child care for family and friends,” the article says.
These demands put tremendous stress on black women’s bodies — and also leave little time and energy for addressing their health needs.
Black women also have a higher rate of obesity than white women or men of either race. Obesity “drives a lot of our leading conditions that lead to high mortality,” Hinton Hoytt says. “Fat just squeezes the life out of us.”
That African American women die more of breast cancer isn’t also well publicized. Black-oriented cable television networks and radio run public service announcements about the dangers of HIV and AIDS, as well as diabetes and hypertension — but breast cancer is rarely discussed in media targeted to the black community.
Black women also haven’t had a prominent role in the breast cancer movement, surmises Karen Eubanks Jackson, founder of the Sisters Network, a national organization of African American breast cancer survivors. White women, she said, see themselves depicted in the media as survivors. “They champion each other as survivors. It’s very difficult for an African American woman to open a magazine and see someone saying, ‘I’m a survivor.’ ” But it’s rare for black women to see themselves projected in that role in magazines.
Genetic factor: triple negative breast cancer?
Another factor leading to higher breast cancer deaths among black women is this: triple negative breast cancer.
Doctors and researchers don’t know exactly why black women are twice as likely as other women to get a diagnosis of triple-negative breast cancer — and this cancer is particularly hard to detect at an early stage.
Most breast cancer types are diagnosed based on the presence of cells that have receptors for progesterone, estrogen or a protein that promotes cell growth — but none of these receptors are present in triple-negative breast cancer.
This also means that it can’t be treated with hormones or other drugs that target those specific types of breast cancer.
Triple-negative breast cancer is treatable — but early detection is even more important because of its aggressiveness.
Dr. Lisa A. Newman, surgical oncologist and professor of surgery at the University of Michigan says she has seen a higher incidence of triple-negative breast cancer –as well as estrogen-receptor-negative cancer — shows up more in black women in the U.S.
This is why she is working closely with a clinic in Ghana, to study whether the higher incidence of triple-negative breast cancer in black women is genetic.
“It’s been remarkable to see that the pattern of breast cancer in this part of Africa really does support our theory that African ancestry in and of itself may be putting us at risk for certain patterns of the disease,” said Dr. Newman, who also is director of the Breast Care Clinic at the University of Michigan.
Not that simple
But there could be many reasons why black women die at a higher rate than white women in some cities, Dr. Sam Harper, who has studied racial differences in breast cancer diagnosis and survival at McGill University in Montreal, tells Reuters Health
“It’s very difficult for a study like this to tell us about the potential causes for the variation in black-white mortality,” says Dr. Harper, who wasn’t involved in the research. Without accurate information, he adds, it’s hard for researchers and policy makers to determine how to reduce the disparities in breast cancer deaths.
Another expert who studies racial differences in cancer at the Harvard School of Public Health in Boston says there are other factors involved. “We know that there are disparities in care, and that is a part of the reason for this,” says David Williams.
“But it’s not just disparities in care. We also know that African Americans get breast cancer at younger ages (and) get more severe types of breast cancers, so that when they are diagnosed they are frequently at a later stage of disease and their disease is more severe,” the adds.
Researchers have investigated the reasons why black women may be more at risk for severe disease, looking at everything from black women’s nutrition, to the jobs they have, and the hair products they use.
More importantly, the study is “just another reminder that there’s a lot of work to be done,” he added. “In a country that values equality so strongly, we really need to make progress in ensuring that every American has access to the best quality health care.”
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